Dr. Jeff Hersh: Psoriasis is a common condition

Q: My daughter has pretty extensive psoriasis. Can you tell me about this disease?

Dr. Jeff Hersh

Q: My daughter has pretty extensive psoriasis. Can you tell me about this disease?

A: Psoriasis is a chronic condition where the body's immune system inappropriately attacks its own skin cells; the blood vessels in the affected skin become engorged and the normal life cycle of the skin cells is disrupted. For some patients other organ systems (such as the eyes or joints) are involved as well.

The specific cause of psoriasis is not understood, but both genetic (about 40 percent of patients have a close family member who is affected) and environmental factors are thought to be involved.

Psoriasis is common; it affects 2 to 3 of every 100 people worldwide. It occurs more in caucasians than those of African descent. Although it can affect people of any age, it more often has its onset either between ages 20 to 30 or between ages 50 to 60.

There can be a variety of skin manifestations from psoriasis, the most common of which is patchy red plaques covered with silver scales. Affected skin may become dry and cracked, sometimes itching and/or burning. Some patients have their nails, eyes (about 10 percent of patients develop some eye involvement, usually not until after they have manifested some skin problems), joints (psoriatic arthritis) or other body systems affected.

Symptoms of psoriasis often flare up for weeks to months then subside, even completely remitting for periods of time. However, there can sometimes be complications of this condition such as:

UInfections: either from compromise of the skin's integrity or from weakening of the immune system from treatments

UPsychological issues such as anxiety, depression, etc., due to the chronicity of the disease and its symptoms (including social issues from the cosmetic aspects of skin flare-ups)

Flare-ups of psoriasis can be triggered by stress, infections, smoking, skin injuries, cold and/or certain medications. Many patients become aware of their triggers and learn to minimize them as much as possible.

The diagnosis of psoriasis is usually made based on the history and physical examination, although rarely a skin biopsy may be needed to verify the diagnosis.

Presently, there is no cure for psoriasis, so the focus of treatment is to improve symptoms (for example, smooth the skin and reduce plaque formation and inflammation) and prevent complications, while minimizing any medication side effects.

The first steps of treatment for the skin manifestations of psoriasis are lifestyle modifications such as daily bathing (to remove scales and irritated skin), regular moisturizer use, regular exposure to sunlight (being sure to avoid sunburn which can actually worsen the condition), avoiding triggers and eating a healthy diet. When other treatments are needed, there are three main types including phototherapy, topical creams/ointments and other medications.

Phototherapy includes ultraviolet light from sunlight, artificial light sources or even certain specialized types of lasers and is sometimes combined with topical treatments or even systemic medications such as psoralen.

Topical treatments include steroid creams, vitamin D, retinoids, anthralin (a medication that may help normalize DNA activity and which is often used in combination with light therapy), salicylic acid, coal tar and moisturizers.

Systemic therapies (some taken by mouth and some requiring injections) include medications that modulate the body's immune system (such as methotrexate, cyclosporine, hydroxyurea, as well as biological immune-modulators) or other treatments such as vitamin A-related retinoids.

Eye involvement may be treated with topical lubricants and/or topical steroids, but some patients may also require surgery or other treatments. Joint involvement requires treatment for symptoms and often systemic therapies to modulate the underlying disease process.

For many patients, psoriasis is a limited and relatively benign condition associated with periodic flare-ups and remissions. Even for these patients, quality of life and psycho-social issues should not be ignored. However, about 10 percent of patients eventually develop arthritis and other complications from the disease as well as its treatments (such as an increased risk of infection for patients on immune modifying therapies), so it is important that psoriasis patients be closely followed by an experienced physician.